Three major upcoming randomized trials (SUNDAY, IMPROVE-AD, and EARNEST) aim to provide conclusive evidence on whether early thoracic endovascular aortic repair benefits patients with uncomplicated type B aortic dissection.
Does early intervention with thoracic endovascular aortic repair (TEVAR) improve aortic remodeling and long-term outcomes compared to optimal medical therapy in patients with uncomplicated type B aortic dissection?
Three major new randomized trials (SUNDAY, IMPROVE-AD, EARNEST) are recruiting to provide conclusive evidence on whether early TEVAR benefits patients with uncomplicated type B aortic dissection compared to optimal medical therapy.
The mainstay of management for uncomplicated type B aortic dissection is currently optimal medical therapy, targeting blood pressure and heart rate, along with serial imaging. There is a paucity of data that informs whether early intervention with thoracic endografting in this group of patients will promote aortic remodeling and better long-term outcomes. Investigations to date, including the Investigation of Stent Grafts in Aortic Dissection (INSTEAD), INSTEAD-XL, and Acute Dissection: Stent Graft or Best Medical Therapy (ADSORB) studies, have compared thoracic endovascular aortic repair (TEVAR) with optimal medical therapy in patients with uncomplicated type B aortic dissection but have not shown a benefit for TEVAR conclusively. We discuss three major new randomized trials, which will recruit concurrently in Scandinavia (the Scandinavian trial of uncomplicated aortic dissection therapy SUNDAY trial), in the United States (the IMPRoving outcomes in vascular DisEase - aortic dissection IMPROVE-AD trial) and the United Kingdom (the Early aortic repair in patients needing endovascular surgery for type B aortic dissection EARNEST trial), which promise to provide conclusive, level 1 evidence to decipher whether early TEVAR in this cohort of patients in beneficial.
Rasiah et al. (Mon,) conducted a review in Uncomplicated type B aortic dissection. Thoracic endovascular aortic repair (TEVAR) vs. Optimal medical therapy was evaluated. Three major upcoming randomized trials (SUNDAY, IMPROVE-AD, and EARNEST) aim to provide conclusive evidence on whether early thoracic endovascular aortic repair benefits patients with uncomplicated type B aortic dissection.